急性肠系膜血管缺血性疾病诊治体会

Experience in diagnosis and treatment of acute mesenteric ischemia

目的观察急性肠系膜血管缺血(acute mesenteric ischemia, AMI)性疾病的临床诊治疗效。方法回顾性分析2013年1月至2018年12月收治的65例AMI患者的临床资料,总结诊治经验。结果 AMI多见于老年人,主要病理类型为动脉栓塞、动脉夹层及动脉血栓形成。不同AMI内科合并症及临床表现存在差别。65例中,25例接受开放手术治疗,40例接受介入治疗;54例获得症状缓解,3例出现短肠综合征,3例自动出院,5例在院期间死亡。动脉栓塞、动脉夹层组开放和腔内手术疗效差异无统计学意义,动脉血栓形成组中腔内手术疗效明显优于开放手术组(92.9%vs 40.0%,P=0.0128)。介入手术相比较开放手术而言,手术时间短、术中出血少、住院时间短、手术并发症少。结论内科合并症及特征性临床表现有助于诊断AMI类型。开放手术及腔内介入手术均为有效治疗方式,对于发病时间<24h、无腹膜炎体征、无溶栓禁忌证患者可首选介入治疗。

Objective To summarize the experience on diagnosis and treatment of acute mesenteric ischemia(AMI).Methods The clinical data of 65 patients with AMI admitted in hospital from January 2013 to December 2018 were retrospectively analyzed.Results AMI was common in the elderly.The main pathological types of AMI were arterial embolism,dissection and thrombosis.Of 65 patients,25 underwent open surgery and 40 underwent interventional therapy.After surgical treatment,54 patients had relief of clinical symptoms,3 had short bowel syndrome,3 patients were discharged against medical advice,and 5 died during hospitalization.There was no significant difference in the therapeutic effect between open and endovascular approaches for patients with arterial embolization or dissection.But for patients with arterial thrombosis,the efficacy of endovascular surgery was significantly better than that open surgery(92.9%vs 40.0%,P=0.0128).Compared with open surgery,interventional surgery had shorter operation time,less bleeding,shorter hospital stay and fewer complications.Conclusion Medical complications and clinical manifestations can assist to judge the type of AMI.Conventional surgery and endovascular interventional surgery are both effective for patients with AMI.Interventional therapy is preferred for patients with less than 24 hours of onset,no signs of peritonitis and contraindication of thrombolysis.